Heroes Not Zombies

I’m a strong advocate of individual health care.

What I mean by that is that I am wary of health care delivered on the basis of statistics and generalities.

It was not my experience as a General Practitioner that I always knew best. I might try my best every day, but every day there would be patients whose blood pressure had not come under control, whose infections had not cleared up, whose pain was not relieved. So every day I had to modify my decisions and change them to better suit the individuals who came to see me.

Health care practiced on the front line makes you wary of generalisations. You quickly realise you can’t apply the same treatments to everyone with the same conditions.

I think there are three main, rational, real life reasons underpinning that experience.

Firstly, every individual is unique. Not only are no two individuals the same biologically, but every individual has their own history, their own influences, potentials and predispositions. Added to that every individual has their own beliefs, values, preferences and priorities.

Secondly, life is an emergent phenomenon, and so, so is health. There is no such thing as simple cause and effect in Nature. No intervention produces predictable outcomes in all circumstances.

Thirdly, life is not a series of discrete events. There is a lot of talk in health care about outcomes, but what are outcomes? Life is a process. What happens today is influenced by what happened yesterday and what might be possible tomorrow, and all of that will change every single day.

In my view, the health care choices for each individual are best left to the doctor and patient together in their ongoing relationship, not decided by politicians, insurance companies, managers or drug companies.